Clinical StudyPercutaneous vertebroplasty compared with conservative treatment in patients with chronic painful osteoporotic spinal fractures
Introduction
Vertebral compression fractures (VCF) are the most common complication of osteoporosis [1], [2], occurring in 20% of those over the age of 70 years [3]. These fractures represent an important cause of disability and morbidity in the elderly, and they have a negative effect on quality of life, physical function, mental health and survival [4]. Before the introduction of percutaneous vertebroplasty (PVP), conservative treatment (CT) and surgery were the two most commonly used management strategies for vertebral fractures. Conservative measures, including rest, analgesics, anti-inflammatory drugs or the use of external braces may be useful for the relief of pain, but contribute little to vertebral stability, especially in the case of chronic osteoporotic vertebral fractures. Furthermore, chronic medication can produce undesirable side effects, while excessive rest can exacerbate bone demineralization, increasing the risk of bone fractures. Surgery is often reserved for fractures associated with vertebral instability or neurological compromise, but poor bone quality and functional performance of patients with osteoporosis reduces the likelihood of a successful outcome [5].
Since its introduction in 1987, PVP has become a widely accepted treatment for patients with painful VCF [6], [7], [8], [9], [10], [11]. The procedure not only results in substantial pain relief, but also provides the possibility of stabilizing vertebral fractures by injecting a small quantity of bone cement into the collapsed vertebral body [6], [7]. A recent systematic literature review demonstrated the effectiveness of PVP in 87% of patients, in terms of pain relief as well as in short- and long-term physical function [8]. However, to our knowledge there have been few reports in the literature of the use of PVP for the management of patients with chronic painful osteoporotic compression fractures. Therefore, the purpose of this study was to compare the efficacy of PVP with that of CT in terms of pain and functional outcome in patients with chronic compression fractures and persistent severe pain.
Section snippets
Study design and patients
This was a single center study of the treatment of chronic compression fractures and persistent severe pain. Patients were recruited from our departments and prospectively allocated to PVP or CT. The Institutional Review Board approved the study protocol and patients provided informed consent before participation.
Between January 2007 and December 2012, 96 consecutive patients with chronic osteoporotic compression spinal fractures on MRI (low signal on T1-weighted and high signal on T2-weighted
Primary procedural results
The technical and initial clinical outcomes of the two groups are shown in Table 2. PVP was technically successful in all patients without complications. Forty-six patients underwent PVP on 69 vertebrae that took place 3 to 5 days after referral to our department, with a technical success rate of 100%. The mean volume of injected cement per vertebral body was 3.6 mL (range, 3–6 mL). AP and lateral spinal radiographs showed cement leakage in 36 (52%) out of the 69 treated vertebral bodies. Leakages
Discussion
Osteoporosis is the most frequent metabolic disease that leads to progressive mineral bone loss with architectural bone changes; it has a prevalence of >30% in females over the age of 65 years [16], and VCF are the most common complication of osteoporosis [1], [2]. Vertebral fractures in osteoporotic patients may be of a minimal degree and go unnoticed, or they can cause acute and intense lumbar back pain, which compromises quality of life. For patients with acute or subacute VCF, CT offers
Conflicts of Interest/Disclosures
The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
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